app.pptx
TRANSCRIPT
![Page 1: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/1.jpg)
Ibrahim Labeda
Makassar, September 16, 2015
APPENDICITIS
![Page 2: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/2.jpg)
APPENDICITIS
Radang pada appendix (usus buntu) Penyebab utama karena obstruksi dipangkal appendix Rasa sakit berawal di uluhati
Tanda klinis : nyeri tekan di daerah Mc Burney
![Page 3: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/3.jpg)
SEJARAH
1736: Appendectomy pertama oleh AMYAND
1886: Kata “appendicitis” diperkenalkan oleh
REGINALD FITZ
1899: MC BURNEY menjelaskan gejala klinis
appendicitis akut dini
1982 SEMM pertama melakukan laparoscopic appendectomy.
![Page 4: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/4.jpg)
Anatomi
![Page 5: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/5.jpg)
![Page 6: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/6.jpg)
![Page 7: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/7.jpg)
Posisi Appendix
![Page 8: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/8.jpg)
Suplai darah Appendix
![Page 9: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/9.jpg)
Risiko Appendicitis menurut umur
![Page 10: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/10.jpg)
Epidemiologi
7% penduduk US 1,1 per 1000 penduduk per tahun Laki-laki : perempuan = 1,4 : 1 Mortality rate 0,2-0,8% Mortality rate pada usia > 70 th = 20% Perforasi paling tinggi umur < 18 th dan
>50 th USA 250.000 apendektomi/tahun
![Page 11: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/11.jpg)
Patofisiologi
Obtruksi
Tekanan intralumen meningkat
Gangguan pembuluh darah
Ganggrene / perforasi
Periappendicular abscess / peritonitis
![Page 12: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/12.jpg)
STADIUM APENDICITIS AKUT
![Page 13: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/13.jpg)
![Page 14: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/14.jpg)
Klinis Laboratorium Radiologis Skoring Laparoskopi
DIAGNOSIS
![Page 15: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/15.jpg)
TANDA & GEJALA
![Page 16: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/16.jpg)
![Page 17: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/17.jpg)
Psoas Sign
![Page 18: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/18.jpg)
Obturator Sign
![Page 19: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/19.jpg)
LABORATORIUM
Angka leukosit Hitung jenis leukosit Urinalisa CRP
![Page 20: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/20.jpg)
Pemeriksaan Radiologis
![Page 21: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/21.jpg)
USG ABDOMEN
![Page 22: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/22.jpg)
CT Scan
![Page 23: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/23.jpg)
Inflamed appendix (A) with appendicolith (a).
CT Abdomen : Appendix Normal dengan appendicolith
![Page 24: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/24.jpg)
MANTRELS score M = migration of pain to the RLQ 1 A = anorexia 1 N = nausea and vomiting 1 T = tenderness in RLQ 2 R = rebound pain 1 E = elevated temperature 1 L = leukocytosis 2 S = shift of WBC to the left 1Total 10Source.”Alvarado, 1986.
![Page 25: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/25.jpg)
MANTRELS Score
skor 7 atau lebih : operasi Skor 5 – 6 : observasi membantu dalam memilih manakah
pasien yang perlu mendapatkan pemeriksaan imaging.
![Page 26: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/26.jpg)
ALVARADO SCORE
1. Appendicitis Point Pain 2
2. Leucositosis (>10.000/mm3) 23. Vomitus/Nausea 14. Anorexia 15. Rebound Tenderness Phenomen 16. Abdominal Migrate Pain
17. Degree of Celcius (>37,3 ْ C) 18. Observation of Hemogram (segmen >75%)1
>8 : Acute Appendicitis5 – 7 : Suspect Acute Appendicitis
AU <5 :Not Acute Appendicitis
![Page 27: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/27.jpg)
KALESARAN SCOREMual : 7/-10Muntah : 11/-5Demam : 7/-27 Nyeri batuk : 15/-20Nyeri ketok : 5/-23Defans lokal : 10/-13Lekositosis : 15/-11
Skor tertinggi : 70 Skor terendah : -109 Cut off point : 20
![Page 28: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/28.jpg)
LABEDA SCOREMual : 4/-12Muntah : 2/-6Demam : 7/-7 Nyeri batuk : 4/-15Nyeri ketok : 10/-9Defans lokal : 16/-11Lekositosis : 6/-7Jenis kelamin Lk/pr : 13/-6
Skor tertinggi : +62 Skor terendah : -57 Cut off point : -10
![Page 29: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/29.jpg)
![Page 30: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/30.jpg)
![Page 31: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/31.jpg)
Tindakan laparoskopi
![Page 32: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/32.jpg)
![Page 33: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/33.jpg)
DIFFERENTIAL DIAGNOSIS
1. Ileitis terminalis
2. Ureteritis
3. Acute mesenteric adenitis
4. Acute Gastroenteritis
5. Penyakit Intestinal lain
6. Pada wanita kemungkinan :
Adnexitis
Cyste ovarium terpuntir
KET (kehamilan ektopik terganggu)
![Page 34: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/34.jpg)
Kalau penanganan terlambat dapat terjadi:
1. Perforasi pada appendix
2. Perforasi ini akan dibungkus omentum menjadi abcess (appendiculair abcess)
3. Abcess pecah akan menyebabkan peritonitis berlanjut ke perlengketan usus dan ileus obstruksi
4. Dapat berlanjut sepsis dan syok yang mengancam jiwa
KOMPLIKASI
![Page 35: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/35.jpg)
Perempuan berumur 18 tahun, keluhan nyeri perut 10 jam lalu
KASUS 1
![Page 36: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/36.jpg)
Anak Laki laki umur 7 tahun, keluhan nyeri abdomen sehari lalu
KASUS 2
![Page 37: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/37.jpg)
Laki laki umur 18 tahun, keluhan nyeri perut 7 hari lalu
KASUS 3
![Page 38: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/38.jpg)
Nona umur 23 tahun, keluhan nyeri perut kanan 4 jam lalu
KASUS 4
![Page 39: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/39.jpg)
Nona umur 30 tahun, keluhan nyeri perut kanan 11 jam lalu
KASUS 5
![Page 40: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/40.jpg)
Nona umur 26 tahun, keluhan nyeri perut kanan 4 hari lalu
KASUS 6
![Page 41: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/41.jpg)
Nona umur 31 tahun, keluhan nyeri perut kanan sehari lalu
KASUS 7
![Page 42: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/42.jpg)
Post Op Laparoskopi Appendektomi day 11
![Page 43: App.pptx](https://reader030.vdokumen.com/reader030/viewer/2022032515/563db823550346aa9a90e661/html5/thumbnails/43.jpg)
Terima Kasih